Do you have plans to move? If so, when & where?

Do you have a fenced yard?

-Select- Yes, fully fenced yard Yes, partially fenced yard Have yard, but no fence Have no yard

If you do have a fence, what is the:

Height: -Select- Short-Under 4 feet Medium-between 4 to 6 feet Tall-6 feet or higher Electric fence Electronic/underground/radio fence

Hold the <CTRL> button to select more than 1 answer

Material: -Select- Chain link Chicken wire Construction/temporary plastic/vinyl Privacy - wood/vinyl Wood slat/log

Hold the <CTRL> button to select more than 1 answer

Condition: -Select- Great-No gaps, no holes Needs work-gaps/missing pieces of fence Needs work-space between bottom of fence & ground N/A

Hold the <CTRL> button to select more than 1 answer

Fence comments

Yard size: -Select- No yard-will use dog park/community areas Small yard Medium yard Large yard Acres of land

Do you have a doggy door?: -Select- Yes - always open Yes - sometimes left open No A what?

Where will the dog sleep?: -Select- Inside-on the floor/dog bed Inside-on my bed Inside-in a crate Inside-on couch/chair Outside-in dog house Outside-in yard Other Other:

When you are at home, the dog will spend its time... -Select- Indoors Mostly indoors Indoors & Outdoors Mostly outdoors Outdoors

When the dog is alone at home, s/he will spend its time... -Select- Loose inside Crated/penned inside Fenced outside Leashed/chained outside

Do you have children in your household?
Yes - infant Yes - todler Yes - preteen Yes - teenager Yes - adult "children" Frequent visits with family/friends with children Frequent visits by neighborhood children No children, but might have/plan on having someday No children - do not plan on having children

To select more than 1 answer, hold the <CTRL> (Windows) or <Command> (Mac) key.

Please list names/ages of household members:

What are everyone's working/school hours? How long will the dog be alone?>/dt>

Does anyone in your household have allergies - or is anyone allergic to pets?

Do you have dogs in the household now?

If so, please list breed/age/gender/spay-neuter status for each:

Do your dogs get along with other dogs in general?

Have you had other dogs in the past? If so, what happened to them?

Have you ever had to give up a pet? If so, please elaborate.

Do you have any cats? If so, how many?

Do you have any other pets? If so, what kind and how many?

Please list your vet's name & phone # (we may call them as a reference)

Does everyone in the household want a Shiba?:

If you have never lived with a Shiba, have you done any research about the breed?

Please explain, and list any websites or books you may have read.

Is there a specific dog you are interested in?

What gender do you want to adopt?
Female
Male

What age do you want to adopt?

Puppy (Under 1yr) Young adult (1-3yrs) Adult (3-9yrs) Senior (10+yrs)

What color coat do you prefer?

Red Red Sesame Black & Tan Cream

What activity/energy level do you prefer?

Couch potato Daily/occasional walks Jog/hike Run/Non-stop exercise

Are you willing to drive/travel to meet a prospective Shiba to adopt?

If so, how far?

Comments/Questions